Josephine Lawson Physiotherapy Clinic - Winter 2008 Newsletter - Issue No. 22

Vocational Rehabilitation For Musculoskeletal Conditions

Historically, musculoskeletal injuries have been prescribed rest for greater or lesser periods, bed rest, time off work, time off sport.

The longer a person is inactive, the more time it takes to get them moving, both physically and mentally. This is due to physical inability and psycho-social factors. Encouraging movement and activity, finding ways around the physical disability whilst allowing the injury to heal has greater benefit to the individual in the long term. They maintain their motivation and the time taken to return to full functional activity is cut.

Musculoskeletal problems involving the work place are not only confined to the results of the work situation (occupational) but also to injuries sustained outside the office that will have an effect on the individual’s abil- ity to work and /or to move about the office (non-occupational).

Early and accessible assessment and treatment will increase recovery rate and reduce recovery time. Good physiotherapy will address, not only the injured part but will maintain the physical function of the rest of the body, thus preventing a downward spiral of inactivity, inability to function leading to dependency and loss of confidence.

Physiotherapy

Is able to fulfil many roles;
• Treat the injury
• Maintain function of the rest of the body
• Assess the work environment and address any issues that will have a direct effect on the injury
• Find ways to work around and with the injury e.g. using a mouse with the other hand, breaking the job down into components and farming out components that are traumatic, leaving those that can be coped with, for a period, re introducing them gradually.

Ergonomic work station assessments

Initial desk assessments for employees with a history of musculoskeletal problems. This will outline any issues with the work station before it becomes a problem. Having the assessment done by an ergonomist who is also a physiotherapist has the advantage of knowledge of anatomy, of how the em- ployee’s problem will be affected by their working environment and therefore how to correct to provide a situation which will not aggravate the existing problem or re introduce an old problem. Desk assessments for employees who have an injury, or who are post operative. Assessing those with occupational musculoskeletal problems such as WRULD, neck and shoul- der pain. An experienced physiotherapist/ergonomist will be able to assess the situation and try to find ways to enable the employee to remain at work. Advising on correct furniture, proper sup- portive chairs, correct desk heights, suitable keyboards and mouse setup.

Back Pain

Back and neck pain have become more prevalent in today’s working environment with increasingly longer periods spent sitting at work. Work stations have been set up to cause minimum disruption to the working day which means less time getting up from the desk.

Cause
Sitting puts greater pressure on the spinal discs than any other position, leading to bulging of the discs which in turn can press on the nerves causing pain. In addition poor posture, such as slouching or sitting with the head flexed for a long time as when reading documents on the desk, can result in weakness of the supporting muscles of the spine, which can lead to greater instability of the verte- bral joints and greater risk of a disc bulge.

Prevention
• Correct set up of the work station
• Getting up from the desk frequently
• Exercise to strengthen core muscles

Correct work station
• Sit close to the desk. Sit at elbow height to the desk so that an upright posture is maintained
• Have the back rest of the chair in touch with and supporting the back
• Have the monitor directly in front and at a height such that the centre of the screen is at eye level
• Keep the mouse and keyboard sufficiently close so that the arms are not stretching too far to the back of the desk thereby encouraging the back to stoop.
• Use a document holder or writing board if there is a lot of paper work to be read and amended

Get up from the desk
Three times an hour, even if it is only for 30 seconds, to relieve the pressure on the spine. Use natural breaks to do this such as, once a task has been completed before moving onto the next, or at the end of a phone call etc.

Exercise
Pilates type exercises will help to strengthen the core muscles to give better stability to the back and neck